Phentermine (Adipex-P), an amphetamine derivative, is the most prescribed weight loss medication in the United States. Available as a low cost generic, phentermine has been approved for weight loss since 1973.
Here are the great questions I hear from my patients over and over:
- How does phentermine work? Phentermine increases release of neurotransmitters which simulate metabolism and suppress appetite. Phentermine is a “sympathomimetic” because it simulates the release and inhibition of certain neurotransmitters in your brain. Essentially it tricks your mind into feeling full!
- Release of which neurotransmitters? A large body of evidence has observed that phentermine works by causing the release of two neurotransmitters, dopamine and norepinephrine, in your brain to suppress hunger.
- Wait, wasn’t this the scary fen-phen drug? Kind of. Here is the story: fen-phen was a mixture of fenfluramine (the “fen”) and phentermine (the “phen”). The fen-phen combination was very popular in 1996, with 6.6 million prescriptions dispensed in the US. Soon after, reports of heart valve disease and primary pulmonary hypertension were reported, caused by fenfluramine (the “fen” part of the drug). In September 1997, the FDA recommended that fenfluramine be withdrawn and that patients should immediately stop taking it. So don’t worry, phentermine was not part of these warnings and has not been shown to contribute to heart valve disease or any lung problems.
- What is the difference between phentermine, cocaine, and amphetamines? A lot. While it is true that they are all considered sympathomimetics, the addictive effects of cocaine and methamphetamines do not exist with phentermine. This is because cocaine and methamphetamines are much more potent releasers of norepinephrine and dopamine, which cause users to experience the addictive effects.
- Who should not take phentermine? Phentermine is not a good idea in patients with coronary heart disease, uncontrolled high blood pressure, hyperthyroidism, or in patients with a history of drug abuse.
- Why is phentermine a “scheduled” drug like Xanax, Ativan or Ambien? Phentermine is a schedule IV drug, which suggests the potential for abuse, although the actual potential is low. If you are concerned, talk to your doctor about the potential for addictive effects.
- How much weight will I loose with phentermine? Phentermine 37.5mg daily for 12 weeks leads to an average weight loss of 15.8 pounds (7.2 kgs).
- Will phentermine give me side effects? Dry mouth is the one i hear most often from my patients, and it doesn’t seem to bother them. Phentermine can also cause increased head rate, blood pressure, insomnia, constipation and nervousness. So keep an eye on your blood pressure if you do decide to start on it.
What has your experience been?
Doctors and medical professionals are finding that varying prescription drug prices are having a serious impact on our health and our wallets. A new study published in the American Medical Association’s primary journal shows just how much prices can vary from one pharmacy to another. Looking at almost 200 pharmacies in the St. Louis area, they found common heart medications being sold for wildly different prices, including:
- Lisinopril. The JAMA study found a price range of $3 – $80.59 for 30 tablets of lisinopril 10 mg. The median price was $9.99. Good news here—you can find prices lower than $9.99 at many pharmacies on GoodRx (and for free at Publix, if you have one near you).
- Carvedilol. Prices for 60 tablets of carvedilol 6.25 mg ranged from $4 – $135.99, with a median price of $14.76. These are just cash prices at local pharmacies! For the same dosage and quantity, you can easily find GoodRx discounts for $less than $10.
- Digoxin. Digoxin (125 mcg, 30 tablets) cash prices ranged from $12.19 – $94.99. Several pharmacies have prices when using GoodRx, including an offer for $9.99 from Rite Aid with a free store membership.
Need more encouragement to shop around? OneMedical breaks down the savings from the JAMA study even further (and recommends GoodRx as a great tool to help you compare prices).
Back in March of 2010, the FDA ordered manufacturers to remove nitroglycerin sublingual tablets (the generic for Nitrostat) from the market until it received official approval. Since nitroglycerin sublingual tablets were produced before the Food, Drug, and Cosmetic Act of 1938 (which required pre-market approval for drugs based on their safety), it had never gone through an official approval process, until now!
You can learn more about this approval here.
What are nitroglycerin sublingual tablets used for?
Nitroglycerin sublingual tablets are prescribed for the immediate relief of chest pain. Most people take them before any physical activity.
How do I take them?
This medication is meant to be taken sublingually, which means “under the tongue.” They can also be dissolved in the cheek, known as buccal administration.
Nitroglycerin should not be chewed, crushed, or swallowed.
It is very important that you monitor your pain when using nitroglycerin sublingual tablets. If after 5 minutes you still have no pain relief, you should call 911 immediately. You may then take up to 2 more doses spaced out from each other by 5 minutes, while waiting for the ambulance to arrive.
What strengths of nitroglycerin sublingual tablets will be available?
Nitroglycerin tablets will be available in the same strengths as the name brand Nitrostat, 0.3mg, 0.4mg, and 0.6mg.
What companies will be making nitroglycerin sublingual tablets?
Dr Reddy’s and Greenstone LLC are the generic manufacturing companies bringing their versions of nitroglycerin sublingual tablets to the market.
Greenstone’s nitroglycerin tablets will be the authorized generic equivalent to Nitrostat, meaning that the product has the same active and inactive ingredients, and look similar to the brand name medication.
On the other hand, Dr Reddy’s tablets will be therapeutically equivalent. This means that it contains the same active ingredients, but may have different inactive ingredients.
Both of these manufacturer’s nitroglycerin tablets have undergone vigorous testing by the FDA to ensure their safety!
The liver is the main organ for maintaining the body’s internal environment. Liver failure is always scary because there is currently no way to protect against the absence of liver function. Think about it this way: we can use dialysis to take over for the kidneys or a mechanical ventilator if the lungs fail . . . but there is nothing to compensate for the liver.
Medications are an important cause of liver injury. While there are more than 900 drugs and herbs reported to cause liver injury, ten medications stand out for their potential to cause liver damage. Two thousand cases of liver failure occur each year in the United States and 50% of them are due to medications. Here are ten medications, both over-the-counter and prescription, that are rare-but-known causes of liver damage.
- Acetaminophen (Tylenol). Of the liver failure cases attributed to medications, 37% are due to acetaminophen. Acetaminophen works well as a fever reducer and pain reliever—but make sure to keep your use under 2 grams a day, and don’t exceed the recommended dose of 4 grams a day. Many over the counter products contain acetaminophen (Theraflu, Nyquil, Dayquil, etc) and that’s where folks get into trouble. Read the ingredients.
- Amoxicillin/clavulanate (Augmentin). Augmentin is an antibiotic used for bronchitis, sinus and throat infections. Liver damage from Augmentin can occur shortly after you start taking it, though signs of liver injury are often detected even after you’ve stopped the medication.
- Diclofenac (Voltaren, Cambia). Any NSAID (non steroidal anti-inflammatory drug) can cause liver injury, but it is most common with diclofenac. Liver injury from diclofenac can happen weeks to months after you start taking it. It is very rare, but affects susceptible individuals for reasons we don’t know.
- Amiodarone (Cordarone, Pacerone) is a heart medication used to control the rhythm in people with atrial fibrillation. After taking it for weeks to months, liver cell injury has been observed.
- Allopurinol (Zyloprim). Taken for the prevention of gout attacks, liver injury from allopurinol may happen within days to weeks of starting it.
- Seizure Medications. This whole class of medications is a problem, as several anti-epileptic medications can cause liver damage. Dilantin (phenytoin) can cause liver damage shortly after you start taking it, which is why your liver tests will be monitored. Valproate, carbamazepine, and lamotrigine can also cause liver injury which may declare itself later, after you’ve been taking it for weeks or months.
- Isoniazid. If you have a positive TB (tuberculosis) skin test (a “positive PPD test”) you may be prescribed 3 – 6 months of isoniazid (also known as isonicotinylhydrazide or INH) therapy. INH is a well known cause of acute liver injury which occurs weeks to months after you start taking it. This is why you are told not to drink alcohol while taking INH.
- Azathioprine (Imuran). Azathioprine is a medication that controls the immune system. It is used in Crohn’s disease and autoimmune hepatitis, among other things. After weeks to months of taking azathioprine, damage to the liver can occur. I’ve seen this happen, keep an eye on the liver while taking this medication.
- Methotrexate. Used for many conditions, including rheumatoid arthritis and ectopic pregnancy, liver levels will be monitored while you are taking methotrexate because of the relatively common adverse liver effects.
- Risperidone (Risperdal) and quetiapine (Seroquel) are both used as antipsychotics and antidepressants. These medications can cause a blockage of the flow of bile from the liver (drug-induced cholestasis).
Honorable mention. You may wonder about the statin cholesterol medications and abnormal liver function tests. While atorvastatin, simvastatin, lovastatin and pravastatin can frequently affect liver function blood tests, they do not tend to cause significant liver injury. Animal studies reveal that very high doses of statins may cause hepatotoxicity (damage to the liver), but typical doses of the drug are not associated with significant liver injury. Liver cell injury from statins is exceptionally rare in humans.
If you have ever had the flu, you know just how down and out you can feel. Besides feeling like a zombie, the most common symptoms of the flu include chills, fever, cough, sore throat, muscle or body aches, headache or vomiting and diarrhea.
With flu season peaking as early as December, it’s important to know the common signs and symptoms, and what can be done to decrease your days spent sick and in bed. We have some useful information to help you detect and beat the flu faster!
Is the flu caused by bacteria?
No, the flu is caused by various types of viruses.
Will an antibiotic cure me of the flu?
No, antibiotics are used to get rid of bacteria and do not work on viruses like the flu.
How is the flu virus spread?
The flu virus is spread from person-to-person via respiratory droppings from sneezing, coughing, talking, or touching.
What can be done if you detect the flu early enough?
If you can see your doctor within 48 hours of your flu symptoms appearing, your doctor may treat you with an antiviral like Tamiflu or Relenza. These antivirals fight the flu virus in the body which may lessen symptoms and shorten the time that you are sick.
Are there any over-the-counter (OTC) treatments for the flu?
Unfortunately, no. There is nothing you can get over-the-counter to treat the flu. There are, however, some over-the-counter items you can get to help manage the pesky flu symptoms! Here are some drugs that might be helpful for certain symptoms:
- Fever and body aches can be managed with OTC pain relievers like:
- Sore throats can be managed with OTC pain relievers, throat sprays, throat drops like:
- Chloraspeitc spray
- Demulcent throat lozenges
- Coughs can be managed three different ways.
- A productive cough (with mucus) can be managed with an OTC expectorant like Robitussan or Mucinex.
- A Dry cough (without mucus) can be managed with Delsym.
- If you want both, you can also try a combination product with an expectorant and cough suppressant like Muxinex DM or Roitussin DM.
- Runny noses can be managed with OTC oral histamines or nasal sprays like:
- Oral antihistamines
- Nasal Sprays
- Flonase Allergy Relief
- Nasacort Allergy 24HR
- Saline nasal spray
- Oral antihistamines